The Costs and Benefits of Intensive Treatment for Cardiovascular Disease

This paper examines the causes and consequences of reductions in cardiovascular disease mortality, and in particular heart attack mortality, over the past several decades. Analysis of data from Medicare and review of the clinical literature indicate that a large share of the recent decline in heart attack mortality is a result of new medical interventions and increased use of existing interventions. Much of the mortality improvement appears to be the result of changes in the use of pharmaceuticals such as aspirin and clot-busting (thrombolytic) drugs. Greater use of these and other intensive medical procedures have increased the cost of treating heart attacks but have also lead to health improvements. We estimate that the value of improved health is greater than the increased cost of heart attack care, so that the cost of living for people with a heart attack is falling. We present preliminary evidence that patients in managed care receive nearly similar treatment for heart attacks compared to patients with traditional indemnity insurance, but that managed care insurers pay less for the same treatments than do traditional insurers.